Motz Patrick, Gray Megan, Sawyer Taylor, Kett Jennifer, Danforth Douglas, Maicher Kellen, Umoren Rachel
Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, WA, United States.
Division of Neonatology, Department of Pediatrics, Mary Bridge Children's Hospital, Tacoma, WA, United States.
JMIR Serious Games. 2018 May 11;6(2):e8. doi: 10.2196/games.9611.
Prenatal counseling at the limits of newborn viability involves sensitive interactions between neonatal providers and families. Empathetic discussions are currently learned through practice in times of high stress. Decision aids may help improve provider communication but have not been universally adopted. Virtual standardized patients are increasingly recognized as a modality for education, but prenatal counseling simulations have not been described. To be valuable as a tool, a virtual patient would need to accurately portray emotions and elicit a realistic response from the provider.
To determine if neonatal providers can accurately identify a standardized virtual prenatal patient's emotional states and examine the frequency of empathic responses to statements made by the patient.
A panel of Neonatologists, Simulation Specialists, and Ethicists developed a dialogue and identified empathic responses. Virtual Antenatal Encounter and Standardized Simulation Assessment (VANESSA), a screen-based simulation of a woman at 23 weeks gestation, was capable of displaying anger, fear, sadness, and happiness through animations. Twenty-four neonatal providers, including a subgroup with an ethics interest, were asked to identify VANESSA's emotions 28 times, respond to statements, and answer open-ended questions. The emotions were displayed in different formats: without dialogue, with text dialogue, and with audio dialogue. Participants completed a post-encounter survey describing demographics and experience. Data were reported using descriptive statistics. Qualitative data from open ended questions (eg, "What would you do?") were examined using thematic analysis.
Half of our participants had over 10 years of clinical experience. Most participants reported using medical research (18/23, 78%) and mortality calculators (17/23, 74%). Only the ethics-interested subgroup (10/23, 43%) listed counseling literature (7/10, 70%). Of 672 attempts, participants accurately identified VANESSA's emotions 77.8% (523/672) of the time, and most (14/23, 61%) reported that they were confident in identifying these emotions. The ethics interest group was more likely to choose empathic responses (P=.002). Participants rated VANESSA as easy to use (22/23, 96%) and reported that she had realistic dialogue (15/23, 65%).
This pilot study shows that a prenatal counseling simulation is feasible and can yield useful data on prenatal counseling communication. Our participants showed a high rate of emotion recognition and empathy in their responses.
新生儿生存极限的产前咨询涉及新生儿医护人员与家庭之间的敏感互动。目前，共情讨论是在高压力时期通过实践来学习的。决策辅助工具可能有助于改善医护人员的沟通，但尚未被普遍采用。虚拟标准化病人越来越被视为一种教育方式，但尚未有产前咨询模拟的相关描述。作为一种工具要有价值，虚拟病人需要准确地展现情绪并引发医护人员的现实反应。
确定新生儿医护人员是否能够准确识别标准化虚拟产前病人的情绪状态，并检查对病人陈述的共情反应频率。
由一组新生儿科医生、模拟专家和伦理学家制定了一段对话并确定了共情反应。虚拟产前会诊和标准化模拟评估（VANESSA），一个基于屏幕的妊娠23周女性的模拟，能够通过动画展示愤怒、恐惧、悲伤和快乐。24名新生儿医护人员，包括一个对伦理感兴趣的亚组，被要求28次识别VANESSA的情绪，对陈述做出反应，并回答开放式问题。情绪以不同形式展示：无对话、有文本对话和有音频对话。参与者完成了一次会诊后调查，描述了人口统计学和经验。数据采用描述性统计报告。对开放式问题（如“你会怎么做？”）的定性数据使用主题分析进行检查。
我们一半的参与者有超过10年的临床经验。大多数参与者报告使用医学研究（18/23，78%）和死亡率计算器（17/23，74%）。只有对伦理感兴趣的亚组（10/23，43%）列出了咨询文献（7/10，70%）。在672次尝试中，参与者77.8%（523/672）的时间准确识别了VANESSA的情绪，大多数（14/23，61%）报告他们对识别这些情绪有信心。对伦理感兴趣的组更有可能选择共情反应（P = 0.002）。参与者将VANESSA评为易于使用（22/23，96%），并报告她有现实的对话（15/23，65%）。
这项初步研究表明，产前咨询模拟是可行的，并且可以产生关于产前咨询沟通的有用数据。我们的参与者在反应中表现出较高的情绪识别率和共情能力。
